Categories
Uncategorized

What Does “Fentanyl” Mean? Where Does Fentanyl Come From? Shining Light on Commonly-Held Misconceptions Regarding Fentanyl

Americans often confuse pharmaceutical fentanyl and its illicit, black-market counterpart. Here are four easy-to-follow examples to help you tell the difference.

We’ve all heard sensationalized reports of fentanyl in news reports. I bet you’ve heard about fentanyl in the news within the past week! If not, you must be living under a fucking rock. 

What is fentanyl? When local news stations, government agencies, or laypeople talk about fentanyl, what do they mean?

Most of us do not have a common understanding of fentanyl. 

Is fentanyl is a prescription painkiller?

How do illicit opioids on the American market end up having fentanyl in them? 

Are diverted fentanyl prescriptions to blame?

Do American illicit opioid users often use prescription fentanyl? 

Is the current rash of fentanyl overdoses caused by prescription fentanyl?

Let’s find out. I’ll be finding recent mentions of fentanyl in news articles published by local, regional, and national publications alike and explaining them briefly.

Example 1

“Congress Takes Notice as Investigators See Rise in Fentanyl”

WBBJ is a local news source in West Tennessee. Outside of Memphis, it’s the only news source in West Tennessee. On January 17, 2020, WBBJ posted an article on its website that began as such:

“Investigators are finding fentanyl on our streets as state leaders work to restrict access to the deadly drug.”

How Can We Classify This Article’s Mention of Fentanyl?

In this case, “fentanyl” refers to illicit fentanyl that’s primarily sourced from illegal Chinese labs that ship fentanyl internationally using run-of-the-mill couriers, such as the United States Postal Service. Chinese vendors network with customers through web-based drug markets accessible via Tor browser. These markets are considered to be part of the “darknet.”

Here in the United States, fentanyl is typically found in other opioids. The two most common illicit opioids in which fentanyl is found are illicit heroin and counterfeit opioid tablets.

Fentanyl found in heroin and counterfeit opioid tablets is never taken from pharmaceutical fentanyl. People are, in fact, sometimes prescribed fentanyl to relieve severe chronic pain. However, formulations of fentanyl available in the U.S., including Actiq lollipops, Subsys under-the-tongue (sublingual) spray, Lazanda nasal (intranasal) spray, Duragesic on-the-skin (transdermal) patches, and quick-dissolving Fentora in-the-cheek (buccal) tablets.

Example 2

“China Bans All Types of Fentanyl, Cutting Supply of Deadly Drug to U.S. and Fulfilling Pledge to Trump”

The New York Times is an international leader in journalism and is the publisher of this article, which came out on April 1, 2019.

China’s chemical and pharmaceutical industries outgrew government agencies’ ability to provide regulatory oversight in the 1980s. Up until 2019, manufacturers in China were legally allowed to manufacture drugs that are typically punished with jail time, probation, and fines in other countries.

Although manufacturing fentanyl in China is illegal now, countless chemical and pharmaceutical manufacturing interests continue to pump out such drugs in a high-quality, voluminous fashion.

These sources provide some 90%, if not even more, of fentanyl and fentanyl analogues that end up getting consumed by American users.

How Can We Classify This Article’s Mention of Fentanyl?

In this article, “fentanyl” refers to high-quality, illicit fentanyl that ends up being incorporated into batches of other drugs — primarily heroin and counterfeit opioid tablets.

Example 3

“Fentanyl Can Lead to Overdoses in Hospitals, Too”

This article was published in March 2019 by the Indianapolis, Indiana-based Side Effects Public Media.

Ohio is known for being ravaged by the opioid crisis disproportionately, having taken more damage than virtually every other state in the union. This article references one of Ohio’s top hospitals — Columbus’ Mount Carmel — and a handful of patient deaths that took place in the weeks leading up to this article’s publication date.

In early 2019, Mount Carmel’s long-time physician Dr. William Husel was let go after an investigation that confirmed that Dr. Husel had been directly involved in the management and upkeep of dozens of patients who had eventually kicked the proverbial bucket as the result of fentanyl overdose.

A quick glance at “Fentanyl Can Lead to Overdoses in Hospitals, Too” will reveal brief descriptions of several patients who had died at the hands of William Husel.

Troy Allison, a 44-year-old male whose wife phoned an ambulance after Troy was experiencing respiratory issues. Just a few hours after Mr. Allison’s arrival, Mrs. Allison received news that her husband was dead. The non-opioid-tolerant patient was administered a whopping 1,000 micrograms’ worth of fentanyl. One study reports the average fentanyl dose in emergency departments is 180 micrograms.

In late 2018, Sandra Castle passed away immediately following the administration of an excessive dose of fentanyl by none other than Dr. William Husel to the tune of 1,000 micrograms. For non-physicians, just know that 1,000 micrograms is a seriously excessive dose!

73-year-old Peggy Francies died roughly a year before Ms. Castle after Husel’s administration of a 200-microgram dose of the ultra-powerful painkiller. Ms. Francies had initially been welcomed to Mount Carmel due to renal failure, which had shortly after yielded an infection of the bloodstream, or sepsis, in other words.

Just for the record, it’s possible for an article to mention hospitalizing people for having misused illicit fentanyl. However, if you glanced at the article, that isn’t what happened — not at all.

How Can We Classify This Article’s Mention of Fentanyl?

In this article, an anesthesiologist misused a hospital’s supply of pharmaceutical fentanyl. This fentanyl holds the same molecular structure as illicit fentanyl. The largest two differences are that:

  1. Pharmaceutical fentanyl is legal to possess by hospitals, physicians like Dr. William Husel, and other medical institutions.
  2. The fentanyl that Dr. Husel used was much more potent and free of impurities than illegally-manufactured and -distributed fentanyl.

Breaking Down Why Pharmaceutical, Prescription-Only Fentanyl Does Not End Up in the American Illicit Opioid Supply

Pharmaceutical fentanyl is not what’s incorporated into counterfeit opioid tablets, heroin, and -– to a much lesser degree — other, non-opioid drugs.

Just for the record, here’s why this wouldn’t work. Fentanyl comes in several different formulations. One popular formulation of prescription fentanyl is that of lollipops such as Actiq. Imagine separating one or two grains salt from a lollipop. During the manufacturing process, the salt became infused into the figurative lollipop. Just as you couldn’t separate salt from a lollipop, you can’t separate fentanyl from an Actiq fentanyl lollipop.

Duragesic is the name brand of fentanyl transdermal patches that slowly release the powerful synthetic opioid through the skin over a 72-hour period. Transdermal patches, to which there are generic alternatives, provide the easiest way for determined users to abuse the extended-release patches.

Depending on the manufacturer, some fentanyl patches host fentanyl in the form of a gel, whereas the other technology simply sprays a thin layer of fentanyl over a durable sheet of plastic; a protective adhesive layer is placed on top of the fentanyl, effectively creating a fentanyl sandwich. This kind of fentanyl transdermal patches can be chewed on for a quicker release, though actually separating fentanyl from this “matrix” technology, as it’s called, doesn’t really happen.

Even the most readily-separable form of fentanyl, Sublimaze, the name-brand form of injectable fentanyl, wouldn’t be worth one’s time. 50-milliliter vials of Sublimaze contain 2,500 micrograms of the drug — or 2.5 milligrams, in other words.

Depending on what source you use, you’ll find that a dose of roughly 3 milligrams’ fentanyl is capable of killing a fully-grown, healthy adult male.

While this is enough for a few uses, don’t plan on getting your hands on Sublimaze, though.

All considered, even the most suitable formulation we can use to isolate fentanyl from the rest of the medication’s ingredients isn’t very practical.

Example 4

“Jackson Man to Serve 6 Years for Distributing Heroin, Fentanyl Mixture That Caused Overdoses”

This article is also from Jackson’s WBBJ and was published on May 31, 2019. A 67-year-old man was sentenced to six years’ federal prison time for heroin-fentanyl mixture distribution throughout Central-West Tennessee’s Gibson County and Madison County. He was sentenced to this time for being caught distributing between 100 and 400 grams of the mixture.

The United States Attorney General’s Office shared with WBBJ that the 67-year-old admitted to the distribution of a minimum of 100 grams’ heroin-fentanyl mixture. The report goes on to say that at least two end-users of the combination opioid suffered an opioid overdose. Fortunately, both of the users ended up making it.

The man was undoubtedly feeling nothing short of bummed when he caught wind of the fact that a federal grand jury returned an indictment spanning a total of eight counts against the 67-year-old man. 

Of course, he didn’t end up getting sentenced for all eight counts, though that’s not to say he won’t be doing some serious time in the Federal Bureau of Prisons.

After the man serves 80 consecutive months — the sentence began on March 1, 2019 — he’ll be required to adhere to four years’ parole following his release.

How Can We Classify This Article’s Mention of Fentanyl?

In this article, the fentanyl undeniably came from an illicit source. It’s not clear whether the distributor sourced heroin locally and fentanyl from a Chinese source via one of the dark net’s illicit good retail vending sites.

Unless a newspaper, county clerk’s office, news agency, or another source specifically states that someone was arrested with fentanyl in a diverted prescription form, you can safely assume the fentanyl came from an illicit source.

What You Need to Know About Fentanyl

Fentanyl is fentanyl is fentanyl is fentanyl.

You might be surprised to learn that healthcare practitioners across the United States have fielded countless concerns from patients about being administered fentanyl, whether that be for general anesthesia, advanced pain management, the acute management of severe pain in emergency room settings, or otherwise.

The primary difference between fentanyl sourced from pharmaceutical companies through prescriptions from licensed physicians and its illicit counterpart is that the former is more reliable thanks to market regulation. Thanks to a lack of regulation, the modern American illicit opioid market is home to dangerous things like heroin-fentanyl mixtures of unknown potency regularly being sold as “heroin,” fentanyl-filled opioid tablet replicas that seem legitimate but don’t contain the active ingredient they’re advertised as having, and some counterfeit tablets and batches of heroin having inactive ingredients that cause sometimes-severe allergic reactions in users.

Put simply, due to the unregulated nature of the market, illicit fentanyl is inherently dangerous! Further, the illicit American opioid market is similarly dangerous.

As long as a licensed physician you trust prescribes you a pharmaceutical formulation containing fentanyl or directly administers fentanyl in a hospital-type setting, you’ve got nothing to worry about.

Planning on Using Fentanyl?

If you ever come across any substance that tests positive for fentanyl or is known to be a potent batch of fentanyl, you should consider volumetric dosing.

Volumetric dosing consists of dissolving your drugs in water to dose more consistently. Working with fentanyl in powder form is difficult because it’s so potent. Making a mistake can mean you don’t feel anything at all, or you might end up dying.

While you should unarguably avoid fentanyl from the jump, if you insist on using fentanyl, resort to volumetric dosing if at all possible.

By Daniel Garrett

I'm a self-employed writer, long-term drug user, and resident of rural Tennessee. Find me on Twitter at @DanielGarrettHR or email me at danpgarr@ut.utm.edu.

One reply on “What Does “Fentanyl” Mean? Where Does Fentanyl Come From? Shining Light on Commonly-Held Misconceptions Regarding Fentanyl”

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.